Following is a section of a report from the inspector general’s office at OPM warning of the potential health consequences of the continued lower use of preventive care in the FEHB program, a trend that started with the lockdowns at the onset of the pandemic and that still has not returned to pre-pandemic levels.
In our last three semiannual reports to Congress, we expressed concerns regarding preventive care utilization by FEHBP members. While in our last semiannual report to Congress we demonstrated that preventive care utilization had increased significantly in the second half of 2020, and continuing in the first half of 2021, it was still not high enough to offset the procedures missed during the height of COVID-19 lockdowns. This continues to be the case.
The number of individuals covered by the FEHBP health care carriers included in our analysis increased by 1.54 percent from 2019 to 2020. We now know that there was an additional 1 percent increase in covered individuals in our sample from 2020 to 2021. As such, we should have seen a routine increase in preventive care utilization of about 2–3 percent for 2021 compared to prepandemic levels in 2019. It is important to keep in mind that this increase in utilization would appear to be a return to normal levels but would not necessarily make up for all of the missed procedures in 2020. In 2021, this expected routine increase was only observed in March and June.
In fact, in most months in 2021, preventive care utilization remained an average of 5 percent lower than 2019 levels. In January 2022, while COVID-19 cases were again peaking, preventive care utilization levels were 22 percent lower than January 2019. When considering the increase in member enrollment, this is about 24–25 percent lower than expected, potentially suggesting about 59,000 preventive care services missed in January 2022 alone.
Pediatric Immunization Rate
Further, while some types of preventive care services are returning closer to prepandemic levels, others are not coming close. Rates of preventative care in pediatric immunizations continue to be observed at lower rates than those seen in 2019.
As mentioned in our previous semiannual report to Congress, this is not a new or unrecognized phenomenon. This downward trend in pediatric immunization rates has been reported on by the American Academy of Pediatrics, the World Health Organization, the CDC, and the Washington Post. However, we find it important to note that even though lockdowns have ended in the U.S. and COVID-19 vaccinations are now available to most individuals, these concerning trends have not been completely righted. In fact, the rate of pediatric immunization was significantly lower in January 2022 than any month in 2017, 2018, or 2019. This is particularly concerning now, given that most children have returned to in-person schooling, greatly increasing the risk of outbreaks of vaccine-preventable diseases among unvaccinated children.
Occurrence of Metastases in Various Types of Cancer
In our preventive care analysis in previous semiannual reports to Congress, as well as in our preventive care services data brief, we have included trends in utilization of some routine cancer screening services, including mammograms and prostate exams. We expressed concerns that delays in obtaining these services could lead to later-stage diagnoses of certain types of cancer, which in turn could lead to an increase in aggressive therapies and negative side effects.
Looking at rates of change since 2017, we did see a decrease in overall diagnoses of a few types of cancer in 2020, including breast cancer, colorectal cancer, lung cancer, and prostate cancer. These are the types of cancer for which routine preventive care exists and is recommended, at least for high-risk individuals. It follows logically that as preventive care visits were missed, so too were diagnoses of these cancers. On the other hand, diagnoses of types of cancer for which routine screening is not recommended, including ovarian and pancreatic cancers, did not decrease in 2020.
To examine this further, we analyzed the percent of cancer cases that included diagnoses of secondary neoplasm, as shown in Exhibit 8. Secondary neoplasm refers to cancer that has spread (metastasized) from the place where it originated to other parts of the body. The results of our claims analysis seem to support that when preventive screening fell in 2020, rates of secondary neoplasms increased for those types of cancer where preventive screening can normally detect some cases early, before the cancer has a chance to metastasize.
The good news is the increase in occurrence of secondary neoplasm was relatively small for all types of cancer we analyzed. However, we do not wish to make light of these effects, given that this small percentage increase corresponds to about 1,400 additional FEHBP members suffering from cancer which has metastasized, increasing the need for aggressive treatments, which can lead to the devastating side effects mentioned in our preventive care data brief. Nevertheless, we do recognize that, as of now, it appears the effects of the decrease in preventive care utilization since the beginning of the pandemic have not been as severe as they could have been.